title: Role of long-term biliary stenting in choledocholithiasis.
abstract: OBJECTIVE
  Endoscopic retrograde cholangiopancreatography (ERCP) is the treatment of choice for the management of choledocholithiasis. Biliary stenting facilitates repeated attempts at stone extraction. The aim of the present paper was to assess long-term outcomes of patients where biliary stenting was used as the primary treatment for the management of choledocholithiasis.
  
  
  METHODS
  We undertook a review of a prospectively maintained database of all ERCP carried out at a single institution. All patients had stones not amenable to endoscopic retrieval.
  
  
  RESULTS
  Between January 1998 and December 2008, 3655 ERCP were carried out in our unit. Of these, 201 (120 female) patients met our inclusion criteria. All patients underwent ERCP and sphincterotomy, followed by insertion of a double pigtail 7-Fr plastic stent. Repeat ERCP was not scheduled routinely. Stent change was only carried out in patients when clinical suspicion of stent blockage occurred. Median stent patency was 59.6 months (interquartile range 47.7-71.2). At 6 months, stent patency was 93.5%, and at 24 months, it was 81.9%. Serious adverse outcomes with blocked stents were uncommon, and tended to occur early. Cholangitis was seen in only 7.4% (6) of patients (median stent patency 11.8 months) and jaundice was seen in 18.5% (15 patients, median stent patency 7.2 months).
  
  
  CONCLUSIONS
  Our data demonstrate median stent patency of almost 5 years. The low incidence of significant complications with blocked stents and excellent stent patency rates suggest that long-term biliary stenting is an acceptable alternative in elderly, frail patients with stones that are not endoscopically retrievable.
authors.affiliation: Department of Gastroenterology, St Luke's Hospital, Kilkenny, Ireland. slattery.eoin@gmail.com
authors.forename: Eoin
authors.initials: E
authors.lastname: Slattery
authors.forename: Vikrant
authors.initials: V
authors.lastname: Kale
authors.forename: Waqas
authors.initials: W
authors.lastname: Anwar
authors.forename: Garry
authors.initials: G
authors.lastname: Courtney
authors.forename: Abdur R
authors.initials: AR
authors.lastname: Aftab
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D042883:Choledocholithiasis / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: choledocholithiasis; endoscopic retrograde cholangiopancreatography (ERCP); stent